Yakushijin, Y., Shikata, H., Takaoka, I., Horikawa, T., Takeuchi, K., Yamanouchi, J., . . . Yasukawa, M. (2011). Usage of granulocyte colony-stimulating factor every 2 days is clinically useful and cost-effective for febrile neutropenia during early courses of chemotherapy. International Journal of Clinical Oncology, 16, 118–124.

The purpose of the study was to evaluate the clinical efficacy of G-CSF and cost of daily versus every other day G-CSF for preventing and reducing duration of febrile neutropenia.

After treatment with the first course of R-CHOP, 100 mcg per person, G-CSF subcutaneously was begun when the white blood cell counts (WBC) were less than 1.5x10⁹/L and/or neutrophil counts were less than 0.5 x 10⁹/L. Patients were randomly assigned to receive G-CSF daily or every other day. Treatment was stopped when WBC recovered to greater than 5 x 10⁹/L. Total dosages and duration of G-CSF and any subsequent antibiotics were used for cost calculations

• 30 participants
• Mean age was 66 years, with a range = 24–80
• 53.3% were male; 46.7% were female
• All had diffuse large B-cell non-Hodgkin lymphoma and were receiving R-CHOP chemotherapy.  There was no bone marrow involvement
• All had ECOG performance status of 0–3.  Baseline WBC counts were similar in both groups
   

Single site

Active antitumor treatment

 Randomized, controlled trial

Recovery of WBC as defined required 4.0 ±1.4 days and 4.0±1.3 days in those receiving daily and every other day G-CSF respectively. Neutrophil count recovered in 3.4±1.1 days for those receiving daily treatment and in 3.6±1.4 days in those given G-CSF every other day. In the daily use group, three patients developed febrile neutropenia, and two patients in the every other day group developed febrile neutropenia. The same number of patients in each group who were given prophylactic antibiotics developed febrile neutropenia. Cost of treatment in those receiving daily G-CSF was significantly higher than cost in the every other day group (p < 0.0001).

There was no clinical difference in WBC and neutrophil recovery time between patients who were given daily or every other day G-CSF during a course of R-CHOP chemotherapy

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Limited study duration and duration of follow-up

Findings suggest that less frequent G-CSF administration may be as effective as daily administration to facilitate WBC and neutrophil recovery. Further larger scale research in this area is warranted.  If this approach is further supported, it can provide less costly care to achieve desired results.